Marie Moloney (Labour)
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I thank the Minister of State for coming to the House. I expected the Minister for Health, Deputy Varadkar. I mean the Minister of State no disrespect, but this matter is under the remit of the Minister for Health. I regret that I have to bring this matter to the floor of the Seanad. I have tried every other avenue open to me.

The lady concerned was the holder of a discretionary medical card for many years. Her case was due for review and she reapplied and was refused. She did not even receive a GP visit card. She reapplied a second time and was again refused. The case was reviewed and appealed, and was unsuccessful. I have to raise this issue here because when I rang the medical card office the person to whom I spoke would not even acknowledge that the women had had a discretionary medical card. He kept telling me that it did not show up on the computer. That was the answer I kept getting from him, which was absolutely appalling. I just had to hang up. I asked how the person could explain the fact that this woman's husband had not received a medical card if it was not a discretionary card.

The lady has a very complicated medical history. She suffers from arthritis, osteoporosis, hyperthyroidism, hiatus hernia, polymyalgia rheumatica and two other conditions that I cannot even pronounce, which are written down here if the Minister of State wants to read them. She has had one knee replacement and is awaiting another, but the operation cannot be carried out as a result of poor healing because of her polymyalgia and other ongoing conditions. She is a priority for surgery. She also has inflammatory disease, with swelling and deformity of MCP joints in her hands. She has no option but to attend a GP more than 20 times a year, along with very regular blood monitoring. She also has to attend the hospital for outpatient assessments on a regular basis. Along with all of this, she has to undergo surgery again, which will necessitate a lengthy stay in hospital. One consultant refused to take her on because her medical condition was too complicated. One can see why she is extremely worried about the cost of her health care.

On top of that, her husband is also on medication. He is 65 years of age and has the option to continue working until the age of 66 if he wants to, but he has to weigh up his options. If he gives up work and claims social welfare, that will be their only income. She is in receipt of invalidity pension and he will receive jobseeker's allowance for nine or 12 months. When one is in receipt of social welfare as one's only source of income, one receives a medical card. That is how much value they place on a discretionary medical card. The couple applied for one only for the wife. Their financial circumstances had not changed, and they could not understand why the medical card was taken away.

I understood that all of those who had discretionary medical cards which were removed had them returned after the furore a year or two ago.The woman in question is on an invalidity pension, meaning the Department of Social Protection recognises she has a complicated medical condition but the Department of Health does not.

Damien English (Meath West, Fine Gael)
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I thank Senator Marie Moloney for raising this issue which I am taking on behalf of my colleague the Minister of State, Deputy Kathleen Lynch, who apologises that she could not make it due to a previous commitment.

In accordance with the Health Act 1970, as amended, eligibility for a medical card is awarded where a person cannot arrange GP, general practitioner, services for themselves and their family without undue hardship, having regard to their financial circumstances. With regard to this particular case, it would be inappropriate to discuss the family circumstances and their financial details in public in the Seanad. However, I understand from the HSE, Health Service Executive, that in this particular case, in February 2011 the local health office did not issue the medical card on the basis of the HSE exercising discretion. It was not a discretionary medical card at that stage in 2011. In a later review in September 2014, the applicant's income was found to be in excess of the qualifying means threshold. The person's application was referred for a further review to see if the HSE could exercise discretion in this case. However, the outcome was that there was no evidence that the applicant faced undue hardship in arranging medical services. Subsequently, the applicant appealed this decision to the appeals office. The application was further examined and the appeal was unsuccessful.

The Senator is also seeking confirmation that all those who had discretionary cards removed over the past several years have had them reinstated. In June last year, the Government decided that medical cards or GP-visit cards would be reinstated to persons with a serious medical condition or disability who had the renewal of their discretionary card refused by the HSE, having completed an eligibility review between 1 July 2011 to 31 May 2014. Almost 11,400 persons who met the criteria have had their discretionary cards reinstated.

The person to whom the Senator referred did not hold a discretionary medical card. Discretion continues to be an integral part of the medical card assessment process. All applications are assessed under the relevant legislation and the HSE's national assessment guidelines. If the circumstances of this particular applicant have changed since the last assessment, I advise the person to contact the HSE to make a new application. Every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines.

As part of the suite of actions that the Minister for Health, Deputy Varadkar, and the Minister of State, Deputy Kathleen Lynch, announced in November 2014, the medical card system is now operating in a more sensible and sensitive manner. The HSE is exercising greater discretion. This is evident in the number of discretionary medical cards in circulation which has increased by 56% from almost 52,000 in mid-2014 to over 81,000 at the end of February this year.

I hope this clarifies the individual case for the Senator and reassures her that the medical card system is now operating in a more sensible and sensitive manner. The HSE has made it very clear that it was not a discretionary medical card in February 2011.

Marie Moloney (Labour)
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If it was not a discretionary medical card, why did the person's husband not have a medical card? Why did she get a medical card when her financial circumstances are the same now as they were back then? Nothing has changed and the thresholds have not increased. There seems to be some sort of a communication breakdown in this case. This woman had a discretionary medical card - the HSE may not want to call it that - because of her health condition while her husband did not have one.

The only option left for this woman is to take her case to the Ombudsman because she obviously has been treated unfairly. I will suggest she follows this course of action as it is the only one to prove the HSE made a mistake.

Damien English (Meath West, Fine Gael)
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That course of action is open to anybody. The HSE stated it did not issue the medical card on the basis of it exercising discretion. It was not a discretionary medical card. That is where the problem lies.

Marie Moloney (Labour)
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Can it determine what kind of card it was then?

Damien English (Meath West, Fine Gael)
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That is a good question. I will ask Minister of State to check this out. Obviously, the person got a card because of someone’s interpretation of the guidelines.

The Senator’s question is essentially why the card was granted in the first place. I will bring this matter to the attention of the Minister of State, Deputy Kathleen Lynch.